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NPI Code Detail

MEDICARE: DR. CHARLES W BIVENS D.D.S.

MEDICARE:  DR. CHARLES W BIVENS  D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2362TN

General Provider Information

NPI Number : 1528189487
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES W BIVENS D.D.S.
Provider Business Mailing Address
First Line : 1615 WOOD CREEK CIR
Second Line :
City : ATHENS
State : TN
Zip : 37303-4595
Country : US
Telephone Number : 423-745-1287
Fax Number :
Provider Business Practice Location Address
First Line : 800 W MADISON AVE
Second Line :
City : ATHENS
State : TN
Zip : 37303-3430
Country : US
Telephone Number : 423-745-5212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2007
Last Update Date : 07/08/2007

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Directions to “ DR. CHARLES W BIVENS D.D.S.” Practice Location

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